Republic of Serbia

National AIDS Commission, Ministry of Health of Serbia,

Institute of Public Health of Serbia

“Dr Milan Jovanovic Batut”

Reporting period: January 2010 – December 2011

Status at a glance 3 Overview of the HIV epidemic 10 National Response to the HIV epidemic 15 Major challenges faced and actions needed to achieve the goals/targets19 Support required from country’s development partners 20 Monitoring and evaluation environment 21 Annex 1: Consultation/preparation process for this national report 24

Status at a glance

Strategic, Policy, and Programmatic Framework

The Republic of Serbia is a democratic state located in the central part of the Balkan Peninsula, on the most important route linking Europe and Asia. The Republic of Serbia is middle income country with unemployment rate that has reached 19.2 percent in 2010. Belgrade is the capital of Serbia. With a population of 1,576,124 million, it is the country's administrative, economic and cultural centre. It is estimated that almost 24% of the population in Serbia reside in the four key cities of Belgrade, Novi Sad, Nis and Kragujevac. Serbia has 7.5 million inhabitants, primarily characterized by continuing trends of low birth rates and population ageing. According to the most recent census (2002), projected share of elderly persons (65 years and above) was 17.4% in 2008, while persons aged 20 to 39 projected for 27.18%. Over the previous decade, the population in Serbia is growing older, has longer life expectancy, and is decreasing in volume. In 2010, an estimated number of citizens of the Republic of Serbia (excluding Kosovo under UN resolution 1244) were 7,291,346. This compared to data from 2002, when there were 7,516,346 citizens, represents a population decrease of 2.6%. The health status of the Serbian population is consistent with other Central and Eastern European countries but below that of Western Europe. Serbia compares well with similar countries in terms of life expectancy at birth (72.3 years). In terms of principal causes of death, the picture is similar to many developed and transitional economies with high levels of heart disease, stroke, and cancer. Smoking is estimated to be linked to 30% of mortality in Serbia. Poor nutrition and poor diet are also major risk factors. In the past 10 years Serbian society has experienced major changes in moral, cultural, social, economic and general life values and has had to overcome many challenges. All these contribute to public lack of interest and certain intolerance in relation to vulnerable groups. Much work is dedicated to fighting stigma and discrimination, both in the projects, but also through activities of other stakeholders; however results are not yet encouraging. After the overall changes in the society in 2000 and as a follow up of the responsibilities undertaken with the adoption of the Declaration of Commitment on HIV/AIDS at the UN General Assembly Special Session on HIV/AIDS (UNGASS) in June 2001, the Government of the Republic of Serbia established its National HIV/AIDS Commission (NAC) in March 2002, which had been newly re-established in June 2004 and revised in 2008. NAC is the governmental multisectorial body with Ministry of Health as Coordinator and comprises of president and 21 members, including representatives from the Ministries of Health, Interior Affair, Justice, Education, Labor and Social Policy, Youth and Sport, as well as, representatives from Regional and local health authorities, Red Cross of Serbia, NGOs; PLHIV; academic institutions; public medical institutions/organizations, media and also observers from UN agencies (WHO, UNAIDS, UNICEF, UNDP). NAC is tasked to formulate strategic directions for fight against HIV/AIDS, and to define priority activities and coordinate programs and projects dealing with the disease. NAC is currently in the process of reconstruction which is expected to reflect new political context as well as goals defined in the Strategy.

Page 3 of 23 The low prevalence rate and socially conservative values mean that HIV/AIDS is still a low profile issue in Serbia. Its low ratings on the health and social agendas understandably restrict the level of resources. The Government of Serbia designed and developed the national response on HIV and AIDS in line with international standards and approaches. It follows the “Three Ones” principles, establishing a single action framework (National Strategy) and a single country wide M&E system. Government also established a single National AIDS coordinating authority. The assumptions underlying the “Three Ones” approach is that HIV/AIDS is a development issue and requires a multi-sectorial response that is integrated into the national development agenda and many strategic documents. After the broad public debates and consulations with various stakeholders about the most important issues which were conducted throughout the country the new National HIV Strategy for the period 2011-2015 is adopted at March 2011 by the Government of Republic of Serbia. The Strategy is in line with Joint UNAIDS HIV/AIDS Strategy for 2011-2015, the Global Health Sector Strategy for HIV/AIDS 2011-2015, European Commission Communication on combating HIV/AIDS in EU and neighboring countries 2009-2015, Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia 2004 and other relevant international documents. The general goal of the National Strategy for response on HIV and AIDS in Serbia are prevention of HIV infection and other sexually transmitted infections, and providing treatment and support to all people living with HIV.

The Strategy recognizes 7 strategic areas: prevention; health and social protection of people living with HIV (PLHIV); support to people living with HIV; role of local community in the response to HIV; protection of human rights; communication in the area of HIV; and, epidemiological surveillance, monitoring, evaluation and reporting on the national response to the HIV epidemic. Under the strategic area Prevention, Strategy recognize different measurements and activities related to: voluntary counseling and testing; prevention among PLHIV (positive prevention); prevention among most at risk population (such as sex workers, men who have sex with men, injecting drug users, prisoners, uniformed persons, youth – especially those vulnerable on HIV, etc); and, prevention of blood transmitted infections in health facilities. The objectives of preventive programs are, generally: • Lowering the number of newly infected and early diagnosis of HIV infections; • Maintaining a low STI incidence rate; • Increase in coverage of preventive services and increase in quality of the provided services; • Creating conditions within state authorities and institutions, and citizen associations for highly efficient response to persons living with the risk for the purposes of reducing this risk. Further, area of Health and social protection of HIV infected persons includes: • Improvement of life quality of PLHIV; • Creating conditions for early diagnosis of HIV infected persons resulting in successful treatment, including timely treatment of children born of HIV infected mothers; • Continued improvement of quality of provided health care services at all levels; • Securing conditions for timely laboratory testing to monitor successfulness of antiretroviral treatment in PLHIV. Area of Support to people living with HIV includes:

Page 4 of 23 • Recognizing, strengthening capacity and involvement of PLHIV, other civil society organizations and Red Cross in response to HIV epidemic; • Improving quality of services to PLHIV; • Improving quality of life of PLHIV by increased accessibility of health services, care and support to PLHIV and their families. Area of Role of local authorities in response to HIV infection epidemic includes: • Increase of accessibility and coverage of services related to prevention and control of HIV infection and providing support to PLHIV in local communities; • Strengthening of systematic, continued and planned multi-sect oral response of local communities to HIV epidemic. Area of Human rights in the area of HIV includes: • Adhere to, protect and promote human rights of PLHIV. • Adhere to, protect and promote human rights of other sensitive and marginalized social groups • Lowering social, legal, cultural and socio-economic vulnerability with securing comprehensive participation of PLHIV and other marginalized and vulnerable groups in response to the HIV epidemic. • Creating discrimination and stigmatization free environment for PLHIV and other vulnerable and marginalized groups. Area of Communication in the area of HIV includes: • Improving health communication in the response to HIV infection in the field of prevention • Improving communication with the purpose of lowering stigma and discrimination related to HIV infection. Area of the monitoring, evaluation and reporting include: • Timely and adequate reaction to the current epidemiological situation. • Defining effective Benchmarks of HIV infection control supported by evidence on all levels, through securing appropriate data for continued follow-up of epidemiological situation and trends • Improvement of institutionalized network for data gathering and analysis on the level of Republic/province/region • Improvement of the system for monitoring and evaluation of successfulness of comprehensive response to HIV infection epidemic • Development of research capacity of institutions, associations and individuals and support to researches in the area of HIV infection. The National HIV Strategy is based upon the following principles: • Complete guarantee and protection of human rights based on EU recommendations and other international conventions; • Equal accessibility of health and social protection to PLHIV in all vulnerable categories of population over the entire territory of the Republic of Serbia; • Key roles of PLHIV in policy development, planning and evaluation of support and protection programme; • Significant role of young people and other vulnerable population groups in planning, implementation and evaluation of activities set forth in this Strategic plan; • Prevention of HIV transmission by promotion of healthy lifestyles, lowering risky behavior and strengthening individuals and groups • Appreciation and respect of specific/different needs, roles, responsibilities and limitations regarding gender identity, ethnicity, persons with special needs and others. • Privacy protection and confidentiality appreciation at all the levels of activism as set forth by this strategy; • Respect for the dignity of PLHIV;

Page 5 of 23 • Continued inter-sect oral activities in reaching strategic goals, with all the partners in the public, private and non-profit sectors; • Integrated response to HIV epidemic through biomedical aspect and socio-economic factors which increase risk of HIV infection; • Continued education and improvement of skills for all participants involved in implementation process of preventive Benchmarks and • Sustainability of strategic activities in conditions of reduced international donation/aid. A new Law on Psychoactive Controlled Substances was adopted in 2010. The National Strategy for fight against drugs adopted in 2009 is in line with the EU Drug Strategy and covers both drug demand and drug supply reduction.

The National HIV and AIDS programme has been funded from different national sources. Approximately one third of the funds allocated for HIV/AIDS are covered directly through the Central Government contribution, and two thirds (mainly related to treatment and diagnostics) come from Republic Health Insurance Fund. The Government fully covers the costs of blood screening, routine surveillance on HIV and STIs, prevention activities and costs for VCCT services provided by district public health institutes. That amount is covered through Central Government contribution through the MoH budget for activities of «common interest». Costs of methadone and drug dependance treatment, as well as costs for testing on HIV, hepatitis B and C and other STIs by referral is covered by the Republic Health Insurance Fund. Some material support for MMT is provided by Ministry of Health through GFATM HIV Project. In addition, the local and municipal health authorities are increasingly committing resources for implementation of local health programs implemented both by local health institutions and NGOs. It is assumed that this trend will continue and that the additional funds will be available to NGOs from local health budgets in the course of the programme implementation. The first HIV project financed by Global Fund for the Fight against AIDS, Tuberculosis and Malaria was implemented in 2003 –2006 and two further projects financed through the Global Fund are currently underway (2007-2012 and 2009- 2014). Projects are worth nine and twelve million euros respectively. Ministry of Health is responsible for implementation of R6 GF funded HIV project in the period 2007-2012. Together with NGO Youth of JAZAS Ministry of Health is responsible for implementation of R8 GF funded HIV project in the period 2009- 2014. Overall goal of the HIV Project supported by GFATM 6th round is to halt the spread of HIV among all vulnerable groups and to provide care, support and treatment to PLHIV. The overall project goal will be achieved through focus on four objectives: 1. To prevent HIV transmission in people involved in high risk behaviors; 2. To ensure continuity of care and treatment services for PLHIV 3. To create supportive environment for HIV prevention and care; and 4. To strengthen the capacity of the health system for development of the effective, efficient and accessible HIV/AIDS services. In order to achieve these objectives the Project will scale up existing and set up new prevention programs, support PLHIV and their families and support National M&E System.

Page 6 of 23 This Programme is focusing on the risk groups that have been under increased risk due to the social determinants of health, such as poverty, marginalization and involvement in high risk behaviors, and are often hard to reach with mainstream activities or non-mobile health services. These groups include: 1) injecting drug users (IDUs), 2) men who have sex with men (MSM), 3) commercial sex workers (CSWs) , 4) Roma youth 5) prisoners, 6) institutionalized children and children without parental care and 7) people living with HIV/AIDS. All these target groups are highly vulnerable, stigmatized and discriminated, and are not likely to benefit from mainstream prevention activities. GFATM R8 HIV project tends to build on so far achieved results and activities initiated in the R6 HIV project such as: NEP and MMT programs for IDU, out-reach activities and counseling among SW, out-reach activities and counseling among MSM population, out-reach activities and peer education among Roma youth, HIV comprehensive activities and VCT in prisons, Health Life Skills Based Education among institutionalized children, psychosocial and other means of support to PLHIV, etc. The new services that will be provided to groups at risk for HIV and that are not provided within the 6th round of the GFATM grant are: drop-in centres for IDUs, SW, MSM and MARA; distribution of lubricants for MSM; sensitization trainings for police, social workers and medical staff on how to provide services to most-at-risk groups; training of VCT staff in positive prevention; establishment of the system of surveillance of resistance to ART; training of medical doctors in ART prescribing;training of social workers in provision of the legal support to PLWHA; procurement of STIs tests in order to establish STI surveillance system; reduction of stigma by carrying out de-stigmatization mass-media campaigns; training of judges, public prosecutors and lawyers in HIV/AIDS and gender-related discrimination; strengthening the M&E system by employing two staff in the national AIDS office; participation of civil society representatives in international meetings and conferences. The GFATM HIV Projects from R6 and R8 application, boosted cooperation among key stakeholders in the country. The process scaled up communication and consultation between governmental and NGO sector. In the HIV Projects implementation, the members of vulnerable groups are involved in overseeing the programme implementation as CCM members and they act as peer educators within the prevention programmes. They also participate in implementation of planned studies and evaluation activities to ensure their feedback on the effectiveness of activities implemented through this programmes. Specific preventive programmes among military force implemented by Military Medical Academy in Belgrade is funded by USA Government.

In order to monitor the results of the undertaken activities in the reporting period 2010-2011, and progress of national response to HIV and AIDS in line with National HIV and AIDS Strategy, as well as, in line with Political Declaration on HIV/AIDS 2011 and other international declarations and action plans, Serbia selected 29 relevant indicators for reporting (table 1).

Table 1. List of national indicators reported for the period 2010 - 2011

Name of indicator Value Source of data Note 1. Government HIV/AIDS policy / National AIDS development and implementation status: Commission, interview

Page 7 of 23 National Commitments and Policy Instrument – NCPI and European Supplement to the NCPI 2.Percentage of young women and men aged 19.4% Health Survey in 18.5% males versus 15-24 who both correctly identify ways of Population of Republic 20.2% females of Serbia, Ministry of preventing the sexual transmission of HIV Health, 2006 and who reject major misconceptions about HIV transmission 3. Percentage of young women and men 2% Health Survey in 3.2% males versus aged 15-24 who have had sexual intercourse Population of Republic 1% females of Serbia, Ministry of before the age of 15/ Median age at the 17 years Health , 2006 first sexual intercourse among young people aged 15-24 4. Percentage of women and men aged 15-49 7.94% Health Survey in 13.8% males versus who have had sex with more than one Population of Republic 3.6% females of Serbia, Ministry of partner in the past 12 months Health, 2006 5.Percentage of women and men aged 15-49 60.4% Health Survey in 65.3% males versus who have had more than one sexual partner Population of Republic 46.8% females of Serbia, Ministry of in the past 12 months who also reported that Health, 2006 the condom was used the last time they had sex 6. Percentage of sex workers reached with 60.0% Survey among most sty In Belgrade prevention programmes risk populations for HIV and among PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 7. Percentage of female and male sex 87.2% Survey among most sty In Belgrade workers reporting the use of condom with risk populations for HIV and among their most recent client PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 8. Percentage of sex workers who received 58.8% Survey among most sty In Belgrade an HIV test in the last 12 months and who risk populations for HIV and among know their results PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 9.Percentage of sex workers who are HIV- 0.8% Survey among most sty In Belgrade infected risk populations for HIV and among PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 10.Percentage of sex workers who test 4% Survey among most sty In Belgrade positive for syphilis risk populations for HIV and among PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 11.Percentage of men who have sex with 37.1% Survey among most sty In Belgrade men reached with prevention programmes risk populations for HIV and among PLHIV, Ministry of Health and Institute of Public Health of Serbia,

Page 8 of 23 2010 12. Percentage of men reporting the use of Survey among most sty In Belgrade condom the last time they had anal sex with 64.3% risk populations for HIV and among a male partner PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 13. Percentage of men who have sex with 32.9% Survey among most sty In Belgrade men who received an HIV test in the last 12 risk populations for HIV and among months and who know their results PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 14. Percentage of men who have sex with 3.9% Survey among most sty In Belgrade men who test positive for HIV risk populations for HIV and among PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 15. Percentage of men who have sex with 0.7% Survey among most sty In Belgrade men who test positive for syphilis risk populations for HIV and among PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 16.Number of syringes distributed per IDU 125.000 Programme data per year by Needle and Syringe Programmes Ministry of Health of Serbia, GFATM HIV Project, 2012 17. Percentage of injecting drug users 76.6% Survey among most sty In Belgrade reporting the use of sterile injecting risk populations for HIV and among equipment the last time they injected drugs PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 18. Percentage of injecting drug users 32% Survey among most sty In Belgrade reporting the use of a condom the last time risk populations for HIV and among they had sex PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 19. Percentage of injecting drug users who 32.6% Survey among most sty In Belgrade received an HIV test in the last 12 months risk populations for HIV and among and who know their results PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 20. Percentage of injecting drug users who 2.4% Survey among most sty In Belgrade test positive for HIV risk populations for HIV and among PLHIV, Ministry of Health and Institute of Public Health of Serbia, 2010 21. Total number of people on OST in all 1.774 Programme data OST sites Ministry of Health of Serbia, GFATM HIV Total number of OST sites 26 Project, 2012 22.Number of HIV-positive pregnant women 4 PMTCT data, GAK Estimated number Narodni front, 2012 of HIV+ pregnant

Page 9 of 23 who received antiretroviral drugs during the women is less than past 12 months to reduce mother-to-child 10 in 2011 transmission 23.Percentage of infants born to HIV- 100% PMTCT data, GAK Narodni front, 2012 positive women receiving a virological test for HIV within 2 months of birth 24. Distribution of feeding practices All 4 infants PMTCT data, GAK (exclusive breastfeeding, replacement were on Narodni front, 2012 feeding, mixed feeding/other) for infants replacement born to HIV-infected women at DTP3 feeding visit (100%) 25.Percentage of people diagnosed with HIV 99% Departments for HIV Denominator: All infection who need antiretroviral treatment infection treatment, diagnosed HIV cases in 2012 need for ART and who receive it 26. Percentage of people with HIV infection 31.5% Surveillance data, IPH Denominator: All of Serbia, 2012 diagnosed HIV cases in who already need antiretroviral treatment at 2011 but for only 54% the time of diagnosis (Late HIV diagnosis) of cases with i available/reported information on CD4 count at time of Dg 27.Percentage of health facilities dispensing 50% Departments for HIV antiretrovirals (ARVs) for antiretroviral infection treatment, 2012 therapy that have experienced a stock-out of at least one required ARV in the last 12 months 28. Percentage of estimated HIV-positive 71.4% Surveillance data, IPH incident TB cases that received treatment for of Serbia, 2012 both TB and HIV

Data for some of the core indicators were extracted from the existing and available national or integrated bio-behavioral surveillance surveys among defined populations most at risk for HIV (IDU, SW and MSM). Also we have some qualitative analysis on behavior practice and other risk factors at the same time for some of these MARPs as well as data on behavior, quality of life and needs of PLHIV.

Overview of the HIV/AIDS epidemic

Epidemiological overview

The first AIDS cases were registered in 1985. According to current data released by the Institute for Public Health of Serbia “Dr Milan Jovanovic Batut” (the National Institution that has the mandate for surveillance and monitoring and evaluation of the national HIV response) the cumulative number of HIV-infected people reported till 31st December 2011 was 2725, of whom 1594 developed AIDS and 1114 died (1027 AIDS-related deaths and 87 HIV infected people died from cause not related to HIV).

In the period 2010-2011, 275 newly diagnosed HIV cases, 103 AIDS cases and 57 AIDS-related deaths were reported to IPH of Serbia, as well as 9 non-HIV related deaths. The decreasing trend of AIDS cases and AIDS related deaths in the last decade is mainly the result of the introduction of HAART which is fully covered by

Page 10 of 23 Republican Health Insurance Fund since 1997 and increasing number of PLHIV on HAART (graph 1).

Graph 1. Newly diagnosed HIV cases, AIDS cases and AIDS related deaths by year of diagnosis, 1985-2011

300

250

200

150 No of cases of No 100

50

0 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 year of Dg

newly diagnosed HIV+ AIDS cases AIDS related deaths Source: IPH of Serbia “Dr Milan Jovanovic Batut”, 2012

In the period 2002-2011 a total of 1103 newly diagnosed HIV cases were reported in Serbia (925 males: 178 females). Increasing trend of newly diagnosed HIV cases is notified (148 cases in 2010 and 127 cases in 2011 versus 91 cases in 2003), partly due to promotion of VCCT and increasing number of HIV tested people. More than half of all HIV cases diagnosed in period 2002-2011 are reported in Belgrade (613 cases or 56%), and in region of Vojvodina (203 cases or 18%) where the greatest number of people had been tested on HIV.

In recent years increasing trend of reported sexual transmission was notified among newly diagnosed HIV cases (88% in 2011 versus 15% in 1991) and decreasing trend of newly diagnosed HIV/AIDS cases among IDUs (7% in 2011 versus 72% in 1991). Additionally, regarding the HIV transmission categories among newly diagnosed HIV infected people reported in the period 2002-2011 in Serbia, there is clear increasing trend among MSM (52% of all reported HIV cases in 2011 and 57% of all reported HIV cases in 2010 versus 26% in 2002) partly due to increasing number of MSM tested in VCCT sites. At the other side, there is decreasing trend among newly diagnosed HIV cases among IDUs (7% of all registered HIV cases in 2011 versus 17% in 2002) the most likely due to extensive harm reduction programmes implemented within GF HIV projects (graph 2). In the period 2010 - 2011 only one HIV positive child was registered in whom HIV infection is transmitted from HIV positive mother who did not know her positive status during pregnancy and breastfeeding.

In the period 2002-2011 out of 1103 reported HIV cases in Serbia one third were aged 20-29 (346 HIV cases). In the same period only 14 cases aged 15-19 (1%) were notified out of all reported cases, as well as 12 HIV cases among children aged less than 15. The trend of newly diagnosed HIV infected persons in the age group 20-29 is increasing (34% in 2011 and 47% in 2008 versus 22% in 2002).

Page 11 of 23 Graph 2. Newly diagnosed HIV cases by reported mode of transmission and year of diagnosis in Serbia, 1984-2011

100 90 80

70 60

50 % of% all cases 40

30

20 10

0

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

IDU MSM heterosex. hemofil. & blood recipients MTCT unknown Source: IPH of Serbia “Dr Milan Jovanovic Batut”, 2012 Majority of the people infected with HIV in the past were diagnosed at the stadium of clinical AIDS (more than 70%), but in a recent years that trend is changing. Moreover, in the period 2002-2011 there is clear increasing trend of asymptomatic HIV infected persons at the time of diagnosis (68 cases or 54% of all newly diagnosed HIV cases in 2011 versus 14% in 2002) and decreasing trend of newly diagnosed HIV infected people in stadium of clinical AIDS (39 cases or 31% of all newly diagnosed HIV cases in 2011 versus 48% in 2002) (graph 3). The possible explanation for this trend is promotion via mass media of friendly and highly professional VCCT services at all district IPHs which resulted in reduction of stigma and discrimination associated with the HIV testing. The second reason could be increasing availability of free of charge voluntary confidential or anonymous HIV testing with counseling during the whole year, not only in health facilities but also in drop-in centers or in mobile medical units for key population most at risk for HIV (IDU, MSM and SW).

Graph 3. Newly diagnosed HIV cases in Serbia by clinical stadium of HIV infection, 2002-2011

Count of SEX 160

140

120

100 STAGE unknown clinical AIDS 80 not AIDS symp. not AIDS asymtomatic 60

40

20

0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 HIVYR Source: IPH of Serbia “Dr Milan Jovanovic Batut”, 2012

Page 12 of 23 Out of the total of 1594 reported AIDS cases in a period 1985 -2011, three quarters (75%) are males; three quarters lived in Belgrade, near one half (42%) were IDUs and 43% were aged 30-39, followed by age group 40-49 (25%). In the period 2002-2011 a total of 542 AIDS cases had been reported in Serbia (427 males: 115 females). Out of them 163 AIDS cases were reported among MSM, 128 among heterosexuals and 135 among IDUs. In the same period a total of 248 AIDS- related deaths had been reported (198 males: 50 females) and out of them 91 case among IDUs. Out of them 65% were aged 30-49 and 12% were aged 15-29. During 2011, as well as, in 2010 out of total number of reported AIDS-related deaths more than half were reported among HIV infected persons in whom AIDS is diagnosed previously, in the period 1996-2009. The number of PLHIV is continuously increasing due to reduction of deaths and increasing number of newly diagnosed HIV infected persons, so at the end of 2011 there are registered 1611 PLHIV for whom there is no information on death. Estimated PLHIV prevalence in population aged 15 and more was less that 0,1% at the end of 2010. The HIV epidemic in Republic of Serbia is at low level and stable/well controlled according to the available data from routine surveillance, as well as, according to data provided from specific surveys conducted among defined MARPs in 2008 and 2010. The HIV seroprevalence among tested sample of IDUs in Belgrade, Novi Sad and Nis were less than 5%. At the other side the registered hepatitis C prevalence was high, especially among sampled street IDUs in Belgrade (77% in 2010). As we expected the highest HIV seroprevalence was registered among tested MSM during field survey in Belgrade but it was lower in 2010 in comparison with HIV prevalence found in 2008 (3.9% versus 6.1%). Also, HIV seroprevalence among sampled CSWs in Belgrade was lower in 2010 compared with results obtained in 2008 (0.8% versus 2. 2%).There is still risky behavior among IDUs related to sharing equipment for injecting or not using sterile equipment, as well as not consistent using condoms with different sexual partners, as well as, not satisfying safer sexual behavior in MSM population. Also, the percentage of survey respondents from key MARPs who reported being tested on HIV in the past 12 months was pretty low. The results from surveys conducted in 2010 implies a high level of stigma and discrimination which might influence on testing practice especially among those population groups which are already the most socially marginalized.

Knowledge, attitudes and sexual behavior among general population and young people

HIV/AIDS awareness is very high in Serbia, with almost all adolescents (aged 15-19) (90%) as well as adult men and women (91%) having heard about HIV/AIDS, based on results from the most recent national DHS (Source: Health Survey in Population of Serbia, Ministry of Health, 2006). Despite this high level of awareness and the correct knowledge about the main routs of HIV transmission (55% population aged 20-49), only 20% of population aged 20- 49 reject main misconceptions related to HIV (Health Survey in Population of Serbia, Ministry of Health, 2006). In the last national survey the median age at the first sexual intercourse among young women and men aged 15-24 was 17 years. First sexual intercourse in age less than 15 is reported by 2% of respondents aged 15-24 (3.2% males versus 1% females), Also, 26% of young people aged 15-24 reported having more than one sexual partner in the

Page 13 of 23 past 12 months and 75% of young women and men aged 15-24 reported using condom during the last sexual intercourse with non-regular partner among those who have had more than one sexual partner in the past 12 months. Among respondents aged 15-49 7.95% reported having sex with more than one non-regular partner in the past 12 months (13.8% males versus 3.6% females). Among those respondents who had sex with more than one non-regular partner in the past 12 months 60.4% reported using condom during the last sex (65.3% males versus 46.8% females (Health Survey in Population of Serbia, Ministry of Health, 2006).

Impact indicator Key most-at- risk populations: Reduction in HIV prevalence In 2010, within the GFATM R6 HIV Project implemented by Ministry of Health of Serbia, second integrated bio-behavioral surveillance survey among street IDUs aged 18 and more who injected drugs in the past month were conducted in Belgrade and Nis by IPH of Serbia in partnership with local NGO and health institutions (sample size was 371 respondents in Belgrade and 200 in Nis). Respondent Driven Sampling methodology was successfully applied. The results showed that estimated HIV prevalence among respondents was 2.4% in Belgrade (4.7% in 2008) and 4.5% in Nis (1.6% in 2008). The estimated prevalence of hepatitis C was 77.4% in Belgrade (74.8% in 2008) and 60.5% in Nis (58.4% in 2008) (HIV, HCV AND SYPHILIS PREVALENCE ASSESSMENT, RISK BEHAVIOR AND USE OF SERVICES IN THE POPULATION OF INJECTING DRUG USERS IN BELGRADE AND NIS, MoH and IPHS, 2010). For planning purposes a median estimate within the national minimum and maximum was selected to give a national estimate of 30,383 IDU aged between 15 and 59 years in the Republic of Serbia within a range of possible 12,682 to 48,083 IDU individuals in Serbia in 2009 (IPH of Serbia, 2011).

Results from repeated bio-behavioral survey among MSM aged 18 to 59 who have anal sex with male partner in the past 6 months which was conducted in 2010 showed that HIV prevalence was 3.9% (6.1% in 2008) among surveyed MSM in Belgrade and 2% (2.4% in 2008) in Novi Sad (MoH and IPHS, 2010). For men who have sex with men for planning purposes a median estimate within the national minimum and maximum was chosen as the most appropriate giving a national estimate of 55,447 MSM within a range of a possible 20,789 to 90,104 individuals in Serbia in 2009 aged between 20 and 49 years (IPH of Serbia, 2011).

Bio-behavioral survey among SW both sex aged 18 and more who reported selling sex in the past 12 months which was conducted in Belgrade in 2010 within Ministry of Health /GFATM HIV Project showed that the HIV prevalence among tested respondents was 0.8% (2.2% in 2008) (MoH and IPHS, 2010). For planning purposes on a national level it was estimated that there were 3,901 sex workers aged 18-49 with a possible interval estimate of 1,775 to 6,027 in Serbia in 2009 (IPH of Serbia, 2011).

Page 14 of 23 National Response to the HIV and AIDS epidemic

Although the Government has adopted multi-sectorial approach, and appointed NAC to lead the response, the Ministry of Health is the agency that has probably contributed most to the national HIV and AIDS response over the past few years. National surveillance system has been improved and the scaling-up and decentralization of treatment and prevention services across the country has been done. The response to HIV/AIDS was one of the first areas where Government included the civil society since the very beginning of national efforts to combat the epidemic. The proven partnership was further intensified with the creation of the National AIDS Commission in March 2002, joint formulation of the and GFATM 1st round proposal (where side by side Government and civil society organizations were nominated to act as implementing partners), and especially from June 2004 when reformed NAC was created the first comprehensive National Strategy for Fight against HIV/AIDS in period 2005-2010. The climax of the civil society engagement was noted especially in the period 2003-2006 (GFATM 1st round HIV/AIDS Programme implementation) when civil society organizations were actively working with marginalized and hard to reach populations most at risk for HIV, and a couple of new NGOs were created. In addition to the basic requirement for the National response on HIV epidemic, the task of Youth of JAZAS Belgrade as PR is that with the part of civil society in Serbia systematically work to strengthen human and organizational capacity, development of policies and procedures and sustainable development, especially of PLHIV sector which is in Serbia still extremely unstable and completely dependent on money that comes from the Global Fund. Only a consistent application of this principle can enable that organizations involved in the national response to HIV will ready wait for the 2014 and the departure of the Global Fund from Serbia. As a result of the second phase of the implementation of GF supported HIV Programme some surveys were conducted, many documents, broad education of mass-media representatives as well as many media campaigns had been held related to different prevention and anti-stigma and anti-discrimination issues. Within the GF HIV Project drop-in centers for the key vulnerable populations (IDUs, SW, MSM and MARA) were established and this is very important part of HIV and STI prevention. Methadone maintenance treatment is now decentralized and MMT is available in 8 primary healthcare centers but also on secondary and tertiary health care level. Since March 2010 buprenorphine were registered from National Drug Agency as drug for treatment of opiate addiction. Treatment for substance use disorders is financed through social and health insurance (detoxification, maintenance therapy, inpatient treatment of drug dependence and treatment of drug-induced psychoses). Within the HIV project lubricants are procured and are on regular bases provided to MSM and SW. The cooperation with prisons through GF/MoH HIV project has been lifted to a higher level, and those services available in the community are now available in prisons as well (education, VCT services, IEK material, MMT etc). In 2010, the Ministry of Health, through this project, conducted KAP study on HIV/AIDS that covered 1,500 health professionals in 100 health institutions at all levels of health care. Result indicate that health professionals who received education on HIV/AIDS issue possess higher level of knowledge and are more familiar with protection measures and actions to be taken in case of accident that can lead to HIV

Page 15 of 23 infection. In addition, health professionals who have provided services to PLHIV have less stigmatizing opinions. Medical technicians and nurses know less about HIV and have more negative opinions than doctors. However, there is still a need to work on improving the knowledge of health professionals, and the GF HIV project will be carried out trainings with such curricula that will be developed on the basis of the study results. Within the GF HIV project, trainings were held focusing on the health professionals’ supporting approach to HIV vulnerable groups, and in particular MSM. In addition, positive prevention approach for PLHIV has been introduced for the first time. Trainings in this area were held for health care workers, and a brochure on positive prevention was designed. The new strategy recognizes positive prevention within prevention activities. The Office for Cooperation with Civil Sector has started its work in 2011, and it will work on standards and procedures to enable sustainability of work of NGOs and will contribute to the quality of services delivered. Within HIV project, there are constant efforts in improving the capacities of NGOs working in the area of HIV, and regular meetings are held aimed at networking organizations that provide services in relation to response to HIV, both from non-governmental and government sectors.

Voluntary counseling and testing services

A great effort has been made to promote and expand VCCT services. Since 2011, Ministry of Health financed all VCT services, including HIV tests, in all district IPHs, while some number of tests for HIV and hepatitis B and C were provided within GF HIV projects implemented by Ministry of Health. In 2010 a total number of 10,188 clients had been counseled and tested at Public Health Institutions and additionally 2250 out of health facilities during the IBBS surveys and in drop in centers or mobile medical units in which services for the key most at risk populations were provided (IPHS, 2011).

Prevention of mother-to-child transmission

A special attention was given to prevention of mother-to-child HIV transmission. Till the end of 2004 only a few pregnant women were tested on HIV in first trimester of wanted pregnancy by epidemiological indications. The new PMTCT strategy that endorses right of every pregnant women to get tested for HIV free of charge, has been developed and endorsed as a part of the National HIV strategy , 2005-2010, as well as in the new National HIV Strategy, 2011-2015. With support given by the Global Fund HIV Project and UNICEF the routinely voluntary counseling and HIV testing of pregnant women based on “opt-out strategy” was implemented as pilot project in 5 districts (in the 15 biggest Primary Health Care centers) in the period 2005-2006. In 2010 a total of 6313 pregnant women were counseled and tested on HIV (around 10% of all pregnant women in Serbia) versus 991 tested in 2003 and 1384 tested in 2004. Two of all tested pregnant women in period 2005 - 2010 had been diagnosed as HIV positive (in 2008 and in 2010). Data for 2011 will be available in April 2012. At the other side, in period 2010-2011 seven HIV positive pregnant women, newly diagnosed or already known their HIV positive status, decided to have a baby. They were fully covered with HAART and PMTCT protocol, including replacement of

Page 16 of 23 breastfeeding, so at this moment we notified that all children born by HIV positive mothers were HIV negative.

Blood safety All the blood units have been voluntary donated and mandatory screened for HIV since 1987 and the costs of testing as well as promotion of voluntary donations are fully covered by Ministry of Health. All donated blood units are screened using documented standard operating procedures in a high quality manner.

Key most-at-risk populations: preventive services

The coverage of IDUs, SWs, MSM and prisoners with prevetive services in the area of VCT is still low, even though the outreach activities are scaled-up and very well developed. The development of new VCT sites in the framework of the Global Fund Round 6 HIV Project implemented by MoH, increased the accessibility of the service, but didn’t change in a significant way the number of reported people tested on HIV among key MARPs. This is mainly the result of the fact that people do not recognized their risk or avoid to identify themselves as belonging to one of those MARPs. Community outreach needle exchange programme was initiated during 2003 in Belgrade, since January 2005 in Nis and since the end of 2005 in Novi Sad, and recently in Kragujevac within GF/MoH HIV Projects. Programme data showed that since 2007, cumulative number of IDUs reached with NEP was 3,880 at the end of 2011. There is good cooperation and partnership between these NGOs and local IPHs in providing VCT services for IDUs. Also, within the same MoH HIV project, methadone maintenance therapy is supported and at the end of 2011 MMT is available at 26 public health care facilities in Serbia, and additionally in majority of prisons, reaching at the end of 2011 a cumulative total number of 2,719 IDUs since June 2007, when the HIV project started (Ministry of Health, 2012). At the end of 2011 the cumulative total number of 2,663 SWs was reached by preventive programmes in 5 cities through outreach activities since 2007. Since 2009, app. 768 CSWs were actually reached with HIV prevention activities per semester in drop-in centers. At the same period 38,253 MSM were reached with outreach preventive programmes (peer education, counseling, and condom and lubricants distribution) and additionally 9,996 MSM were reached on line via internet. Since 2009, 5128 MSM were actually reached with HIV prevention activities per semester in drop-in centers (Source: Ministry of Health, 2012).

At the end of 2011 the cumulative total number of 6,210 prisoners (78% of inmates in Serbian prisons) was reached by some preventive service in 12 prisons in Serbia. In the same reporting period 1,733 children/young people without parental care aged 12 –19 (72% of total number of children/young people in social welfare institutions/foster families) were reached with life skills based education in 10 institutions and foster families, as well as 25,698 young Roma through outreach preventive programmes (Source: Ministry of Health, 2012). Results from second round of IBBS surveys conducted in 2010 show that 60% of sampled SWs in Belgrade, 20% of sampled IDUs in Belgrade, and 37% of sampled MSM in Belgrade have been reached by preventive activities (Ministry of Health and IPHS, 2010).

Page 17 of 23 Testing rate in the past 12 months and condom use among key MARPs

Stigma to which SWs are exposed and the illegal status of prostitution result in a very low access to preventive services (that are now becoming more client-friendly) and a high under-reporting rate as members of the population often failing to declare their belonging to this population group. Results from second round of IBBS surveys conducted in 2010 showed that 59% of surveyed SWs in Belgrade reported that have been tested in the past 12 months and knows the result of testing, versus 33% of sampled IDUs in Belgrade, and 33% of surveyed MSM in Belgrade (Ministry of Health and IPHS, 2010). Also, results from second round of IBBS surveys conducted in 2010 showed that 87% of sampled SWs in Belgrade were reported using condom with their most recent client, while only 32% of sampled IDUs in Belgrade reported using condom the last time they have sex (29% in 2008), and 64% of surveyed MSM in Belgrade reported using condom the last time they had anal sex with a male partner (67% in 2008) (Ministry of Health and IPHS, 2010).

HIV treatment: antiretroviral combination therapy

Till the beginning of 2008 the ART was available only in Belgrade at Institute for Infectious Diseases in Clinical Centre of Serbia for all PLHIV in need. Since 2008 HIV/AIDS treatment is available through a well organized system, with out-patient and inpatient services available at Clinical Centers in Belgrade, Novi Sad, and Nis and since 2009 at Clinical Centre in Kragujevac. The need for referral obtained by general practitioners in primary health facilities, and the need for clearance from the Local Health Insurance Fund branch in locations outside of the Belgrade, Novi Sad, Nis and Kragujevac are barriers for some PLHIV to access treatment. Establishment of the new treatment sites is accompanied with comprehensive mapping of the medical and social professionals that will be part of the system for provision of comprehensive medical and psycho-social care and support. The stigma that is highly present in Serbia in general population, is present at some level in the health sector, too. A HIV infected person who needs to come for check-ups undergoes through a demanding administrative procedures that are handling referral papers with the full name and diagnosis of the patient. This compromises confidentiality and privacy and causes stigmatization and discrimination in the community. Government of Serbia ensures universal access to HAART and other drugs for prophylaxis and treatment of opportunistic infections for all people living with HIV who qualifies to it. The qualifying criteria are given in National Guideline for Clinical management and treatment of HIV infection in adults which is adopted by NAC in March 2011. The Treatment guideline is developed and revised in line with recommendations given by European AIDS Clinical Society (EACS). The entire cost of the ARV treatment is covered by Republican Health Insurance Fund (around 5 millions EUR in 2010, Republican Health Insurance Fund). In the period 2003- 2011 a significant increase in the number of people on HAART was observed (995 at the end of November 2011 versus 300 in 2003). Estimated number of PLHIV with advanced HIV infection in need for ART is overestimated using EPP and Spectrum model for countries with low level of HIV epidemic and with lack of continuous screening data of some population group such as IDU, patients with STIs, pregnant women, TB patients etc. It is important to procure and sustain diagnostic tests as well as tests for monitoring and evaluation of

Page 18 of 23 success or failure of ARV treatment and to implement palliative care and home based care for those PLHIV in need.

Major challenges faced and actions needed to achieve the goals/targets

Development of a budgeted action plan for implementation of the new National HIV Strategy in the period 2011-2015, as well as, necessary revision and continuous improvement of the overall National M&E framework that will assure better collection of good quality data from different stakeholders and proper triangulation and improvement of data use for better planning and acting in the future is one of the major challenges. The UN TG on HIV/AIDS / UNAIDS has supported defining and implementation of the National M&E System since November 2004.

Introduction of the Second generation of HIV/AIDS surveillance had been a special challenge that the country was faced with in order to provide more comprehensive picture and to monitor trend of HIV and other STIs prevalence in defined most at risk population groups, as well as, to monitor key behavioral data that will offer a better insight in the status of the epidemic or potential negative course. Also, triangulation of good quality data obtained through repeated surveys and adequate programme data will enable comprehensive and sector wide approach in monitoring and evaluation of national response to HIV epidemic and better planning of resources and preventive activities especially among defined key hard to reach MARPs throughout the country.

The period 2010–2011 is characterized by significant progress made in the area of prevention of HIV and reduction of the HIV impact, as well as, reduction the level of stigma and discrimination in the whole society in Serbia. The strong partnership between governmental sector and civil society sector acting to implement the Strategy has been successful. Major prevention interventions have been expanded to national level with scaled-up access to services and programmes for key populations most at risk for HIV. Also, there is need for further strengthening the health system as well as to raise the level of comprehensive knowledge in different populations and professionals. Although the civil sector is present and noticeable in responding to HIV, a need has been recognized for its additional strengthening in the area of monitoring the national response, or in the system’s response to HIV prevention, treatment and care, promotion of systematic and social changes which would decrease new HIVcases, and protection of the rights of the most disadvantaged groups. Coordination and better networking of organizations which deal with HIV directly, and those working on the reduction of risk, and prevention of behaviors which increase the risk of infection, would increase the representative ness of the civil sector in the relevant national and local structures and have an enhanced impact. Further building and strengthening of civil society organizations, especially in areas less well represented and among the young in particular, would be a significant contribution to the prevention efforts. An important role has been played by the significant Global Fund contribution to the Strategy implementation, almost exclusively for prevention interventions and the important national contribution dedicated to prevention, treatment, care and social support.

Page 19 of 23 The main challenges for new National HIV Strategy implementation in the forthcoming period will be to maintain and scaled-up already developed prevention activities and to make sustainable the universal access to good quality treatment, care and support of PLHIV and those affected by HIV through improvement of planning and management of drugs and routine tests for monitoring patients (CD4, PCR) procurement; development of HIV testing strategy for TB patients; improvement of TB infection control in HIV treatment centers; sustainability of CD4, PCR and testing on HIV drugs resistance in accordance with national recommendations. These will require an increased contribution from the national budget. Despite the progress made, the programmes targeting high vulnerable groups are far from reaching enough to make a significant impact. Alternative strategies and innovative approaches based on best practices should be implemented together with a revision of current legislation with objective to encourage programmes where it is necessary. Also, sector wide approach is needed meaning that HIV specific issues need to be integrated in different national plans and programmes and to raise involvement of local community and private sector in response to HIV epidemic. Also,challenges are funding some of the key activities, such as testing on Hepatitis B and C, as well as free of charge HIV testing for greater number of pregnant woman, introduction of new ARV drugs and continuation of procurement of monitoring test for PLHIV for all treatment centers; conducting the cost effective analysis of PLHIV treatment; standardization of OST service at all levels of health care. Also, we are planning to develop wider gender approach and to integrate gender policy in activities of different stakeholders.

Support required from country’s development partners

UN TG for HIV/AIDS members also contributed to the national efforts for better implementation of the priorities highlighted in the National HIV Strategy:  Support to the establishment of the functional One National M&E system (UNAIDS through PAF funds)  Support in formulation of national policies and standards for youth friendly health, social and education services (formal and non-formal), and assessment of the community and health services provided to especially vulnerable young people, including adolescents (UNICEF)  Efforts to strengthen HIV/AIDS/STI surveillance and support the surveillance capacity building (UN TG, WHO)  Assessment and response of the PLHIV opinion on the current available healthcare, and social services (UN TG, UNDP)  Raising funds for the medium to longer term programmes and projects (bilateral and multilateral agencies).

Page 20 of 23 Monitoring and evaluation environment

In 2006, the National HIV/AIDS Office was established as an operational body of the NAC. The Office has been established within the IPH of Serbia, with support from UNDP and UNAIDS. The Office is continued to be funded by domestic sources since 2007/2008. The main functions of the National HIV/AIDS Office are: assistance to the NAC in overseeing implementation of the National HIV/AIDS Strategy; development and implementation of broad capacity building strategy based on continuous needs and resource assessment; development of M&E plan, and establishment of reporting procedures and data flows within the programme, as well as, to provide regular reports based on collected and analyzed different data, to establish and maintain database on programme resources, provided services and financial resources, to enable further strategic planning of activities and to ensure transparency of the program implementation, by establishing information exchange channels and networks, and dissemination of all relevant information to wide audiences, trainings of journalists and health care workers, capacity building of all relevant stakeholders regarding 2nd generation surveillance and M&E and budgetary- based programming and planning. Coverage indicators are defined to incorporate all three levels of coverage within particular service delivery areas. To ensure full participation of implementing agencies, and collection of good quality data, implementers are fully trained on M&E. Strengthening of national M&E capacity, as well as providing training in 2nd generation HIV/AIDS Surveillance was the key activity in Serbia over the last two years period. Local trainings have been made available for selected number of national stakeholders and sub recipients of GF HIV programmes. The national workshops served as consultation forums where all relevant stakeholders participated in revision and harmonization of existing and defining new indictors and designing of functional M&E system on national level. With support of UN TG for HIV/AIDS, UA targets for 2010 related to prevention, treatment, care and support have been set and endorsed by NAC. The Plan for monitoring and evaluation of the strategic response to HIV and AIDS in Serbia in the period 2011-2015 has been adopted by NAC in March 2011. Multi- agency M&E Toolkit was among few resource documents that was used for its development. The plan provided sufficient basis for monitoring key indicators. The National HIV/AIDS Office settled the M&E Unit which is operative body for collecting and verifying data. Within GFATM HIV Projects implemented by Ministry of Health national outcome and impact indicators will be measured through bi-annual repeated bio-behavioral surveillance surveys among defined most at risk populations, as recommended for low and concentrated epidemics. Baseline surveys for collection of these indicators have been done in 2008 and second cycle of surveys in 2010 while the next two rounds are planned to be conducted in 2012 and 2014. In addition, the PIU of MoH for GFATM HIV Project organize regular monitoring visits to implementation sites/organizations, ensuring data verification and advising implementing partners on required improvements in data quality for the purpose of reporting. Since July 2009 introduction of a Universal Identification Code - UIC for every client reported in programme and development of project’s web-oriented data

Page 21 of 23 base has enabled crosscheck of data during and after regular monitoring activities. Also, created minimum package of services, applied from July 2011, for all HIV prevention activities among defined MARPs will allow us to properly measure and compare quality levels for different types of services. Surveillance system for HIV and AIDS and M&E system have been substantially developed from the 6th Round of the GFATM, as well as, further strengthened through MESS activities and by attending courses on 2nd generation surveillance at the School of Public Health “Dr Andrija Stampar” in Croatia and other courses or conferences in country and abroad. Surveillance surveys in six populations most at risk for HIV and among PLHIV are planned to be implemented biannually, aiming to provide the set of core national impact and outcome indicators. Second round of MoH/GFATM integrated Bio- behavioral or only behavioral surveys in 2010 were conducted by the Institute of Public Health of Serbia “Dr Milan Jovanović – Batut” in partnership with relevant governmental institutions, Regional Institutes of Public Health/VCT centers and NGOs, as well as with treatment departments in clinical centers. Strengthening the strategic planning of the national response to the HIV epidemic will be based on monitoring and evaluation of the national response through the analysis of impact and outcome indicators, coverage and other programme data. The Ministry of Health of the Republic of Serbia and its Principal Recipients planned to strengthen the National HIV M&E system, which would meet the requirements of the Global Fund in regard to performance-based funding. Within GF HIV project R8 the MESS assessment workshop was conducted with key stakeholders which was resulted in annual M&E System Strengthening Action Plan (MESS AP) which implementation is partly postponed till the end of December 2011 due to fact that we agreed that the key deliverables, such as new Plan for M&E of national response on HIV and AIDS and Guidelines for supervision of data and intervention quality, need to be in line with new National HIV Strategy, 2011-2015. Moreover, the revision of previous ones and provision of new size estimates of IDU, MSM, and SW population at local and at the national level based on available 2010 survey and relevant programme data by consensus of key stakeholders followed by the final report on MARPs Prevalence in Republic of Serbia with recommendations has been done with assistance provided by external consultant in the period May-July 2011. Moreover, it is planned to finalize and implement the new data base at national level, as well as, on GF HIV projects level in order to improve reporting and dissemination of final reports for different audiences. The key activity in the next period is development of new data flow system and data base for M&E of HIV response on national level; supervision and quality control of data and programs, as well as of reporting system. The major challenge is to oblige CSOs to report standardized data to national level through unique data base for data collecting and reporting. Other challenge in the next period will be collecting data on AIDS spending on national level using NASA or other recommended methodology and improvement in the area of monitoring treatment.

Page 22 of 23 Annex 1: Consultation/preparation process for this national report

The report was prepared by the National Multisectorial AIDS Commission and Ministry of Health of Serbia in close collaboration with the Institute for Public Health of Serbia/National HIV/AIDS Office, civil society, PLHIV and UN TG on HIV/AIDS based on the current policy, strategic approach and latest results of targeted surveillance surveys among populations most at risk for HIV and among PLHIV, as well as, on available programme data. NCPI and ECDC supplement questionnaires were broadly discussed and fulfilled at the consultation meeting of key stakeholders from governmental and civil society sector on March 19, 2012. The draft report was discussed and adopted by key national and international stakeholders on March 30th, 2012.

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